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HOUSEHOLD INSURANCE QUOTE
This form only takes a few minutes to fill in. We aim to send you a quote via email within 24hrs.
If you would like immediate cover or would prefer to answer these questions over the phone, the number to call is FREEPHONE: 08714 230 200.
 General Questions

From what date do you wish your insurance cover to start?
Title

First Name

Surname

Address

Postcode

Contact Telephone Number

Email

Date of Birth

Your occupation

Do you smoke?

Yes  No 

How long have you lived at the property?

How many bedrooms does the property have?

What type of property is it?

Will the property be in joint names?

Yes  No 
Title
First name
Surname
Date of Birth
Occupation
Do you smoke

Yes  No 

 Buildings Quote

Amount to be insured (this should be the full cost of rebuilding not market value)
Approximate year building was constructed (eg. 1970)
Is the building of standard construction ie. brick/slate roof
 Yes  No
Number of years claim free

 Contents Quote
  

Total value of contents to be insured
Do you have valuables which exceed £2,500 Yes No
Do you have a NACOSS approved alarm system installed Yes  No
Are all the external doors secured by five lever mortice locks and key operated windows Yes  No

If you require freezer or fridge cover in excess of £500 please specify
If you require cover for credit cards in excess of £2,500 (per card) please specify
Number of years claim free

 Additional Questions

Please tick the box if anyone in your household

Suffered any loss or damage (whether a claim was made or not) in respect of the events you wish to insure
 Had an application for insurance declined, renewal refused, cover terminated, increased premium required or special conditions imposed by an insurer.
Been convicted, or charged but not yet tried, for any offence other than driving offences.

Please tick the box if any of the following apply to either you or your property:

Used other than private residence

Left unoccupied for longer than 30 days

Have signs of damage by subsidence, heave or landslip or a history of damage by these events

Currently being monitored for any of the above
In an area which is at risk from flooding or has occured in the last ten years
 Occupied other than by you, your partner, any family members of yourself and/or your partner as permanent residence
 Used for any business purposes (this relates to any part of building or grounds)
 Not contained facilities (eg kitchen) lockable entrance door shared
 In a state of structural disrepair
 Roofed with thatch
 

Thank you for completing this form

 
     

PROFILE INSURANCE SERVICES:  52 HIGH STREET, IRCHESTER, NORTHAMPTONSHIRE NN29 7AB
 Telephone: 08714 230200      Fax: 08714230221      Email: profileinsurance@btconnect.com
Profile is an independent intermediary acting for over 40 insurers
  Authorised and regulated by the Financial Services Authority . Firm Ref 300093